Remote eye screening can help diabetics

NEW YORK (Reuters Health) - Eye clinics that screen diabetics who don't make it into a specialist's office may help identify eye problems early on, new study findings report.

A review of recent research found that relatively simple exams by non-specialists who don't dilate the pupils are accurate at spotting early cases of the diabetes-related eye disorder known as diabetic retinopathy.

This type of screening "offers a quick, convenient and cost-effective way to screen for diabetic retinopathy," study author Dr. Hugh Taylor at the University of Melbourne in Australia told Reuters Health.

"With the appropriate camera, clinic staff and technicians can safely and effectively screen for changes without the need for expert ophthalmologists to be on site and (avoid) the time-consuming need for dilating drops that will blur the vision for hours after the examination," Taylor said in an e-mail.

Earlier this year, a study suggested that nearly 30 percent of Americans with diabetes over the age of 40 may have diabetic retinopathy, with four percent of this group affected severely enough that their vision is threatened.

The condition involves damage to the eye's retina and is the leading cause of new cases of legal blindness among Americans between 20 and 74 years old. It also costs the U.S. around $500 million every year.

If caught in the early stages, good blood sugar control can slow the disease down considerably, and laser treatment can prevent severe vision loss, the researchers say. They don't mention whether or not screening in itself has been shown to lead to better outcomes, however.

For the most part, experts recommend that people with diabetes get their eyes checked every year, to spot asymptomatic problems and treat the disease before it leads to blindness.

However, according to some estimates, only half of diabetics follow this advice. One Australian report estimated that getting 80 percent of diabetics to have their eyes checked annually would save the country $15 million each year.

To investigate whether remote clinics can help reach people who would otherwise not visit an eye specialist, Taylor and his team reviewed data from 20 studies that compared the accuracy of eye exams using these clinics to what a specialist would do.

At remote clinics, photographers -- usually not medically trained -- capture a picture of the eye, then send it to a trained professional who grades the eye.

They found that, overall, remote screening picked up 83 percent of people with retinopathy, which Taylor called "very good," and it didn't matter whether or not the photographer had medical training.

On the other hand, the screens falsely labeled 12 percent as having retinopathy even though they didn't, and photographers with less training were more prone to such mistakes.

While false positives can lead to unnecessary treatment and expense, Dr. Thomas Friberg, an eye specialist at the University of Pittsburgh Medical Center, said a few weeks of training is all photographers really need. That will help them locate the important parts of the eye and ensure they are in good focus, allowing experts to spot any problems.

Friberg, who was not involved in the new work, said technological advances since the study was done mean the accuracy of remote screens is probably even higher today.

"We were concerned historically whether most cameras could pick up a pathology," he said in an interview. The authors' results show that such an approach "works rather well most of the time."